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RXDRUG-DR-XY36384

MEROMAX Meropenem Trihydrate 500mg Powder for IV Injection 1's

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Description

Indications/Uses

For the treatment of susceptible infections including Intra-abdominal infections, Gynaecological infections, Meningitis, Respiratory tract infections (including in cystic fibrosis patients), Septicaemia, Skin and structure infections, Urinary tract infections and infections in immunocompromised patients.

Dosage/Direction for Use

The dosage and duration of therapy shall be established depending on type and severity of infection and condition of the patient.
Adults: In the treatment of pneumonia, UTI, gynaecological infections, skin and skin structure infections, the recommended dosage is 500 mg IV every 8 hours.
In the treatment of nosocomial pneumonias, peritonitis, presumed infections in febrile neutropenic patients, septicaemia, the recommended dosage is 1 g every 8 hours.
In the treatment of meningitis, the recommended dosage is 2 g every 8 hours.
Caution is recommended in using meropenem (MEROMAX 500/MEROMAX 1000) as monotherapy in critically ill patients with known or suspected Pseudomonas aeruginosa lower respiratory tract infection.
Use in patients with renal insufficiency: Dosage should be reduced in patients with creatinine clearance less than 51 mL/min as scheduled as follows. (See Table 2.)
 



Meropenem (MEROMAX 500/MEROMAX 1000) is cleared by haemodialysis; it is recommended that the unit dose (based on the type and severity of infection) is administered at the completion of the haemodialysis procedure.
There is no experience with peritoneal dialysis.
Use in patients with hepatic insufficiency: No dosage adjustment is necessary in patients with impaired hepatic function.
Use in the elderly: No dosage adjustment is required for the elderly with creatinine clearance values above 50 mL/min.
Use in children: For children over 3 months and up to 12 years of age the recommended dose is 10-20 mg/kg IV every 8 hours.
In children over 50 kg weight adult dosage should be used.
In meningitis the recommended dose is 40 mg/kg IV every 8 hours.
Febrile episodes in neutropenic patients-the dose should be 20 mg/kg every 8 hours.
Mode of administration: Intravenous bolus injection: Intravenous bolus injection over approximately 5 minutes.
Meropenem (MEROMAX 500/MEROMAX 1000) to be used for intravenous bolus injection should be constituted with sterile water for injection (5 mL per 250 mg Meropenem (MEROMAX 500/MEROMAX 1000)).
This provides an approximate concentration of 50 mg/mL.
Constituted solution are clear, and colorless or pale yellow.
Intravenous infusion: Intravenous infusion over approximately 15 to 30 minutes. Meropenem (MEROMAX 500/MEROMAX 1000) for intravenous infusion may be constituted with compatible infusion fluids (5 to 200 mL).

Overdosage

Should an overdose occurs, the patients should be treated symptomatically.

Contraindications

Meropenem (MEROMAX 500/MEROMAX 1000) is contraindicated in patients who have hypersensitivity to this drug.

Special Precautions

As with other beta-lactam antibiotics, rare hypersensitivity reactions have been reported.
Before therapy with Meropenem (MEROMAX 500/MEROMAX 1000) is instituted, careful inquiry should be made concerning previous hypersensitivity reaction to beta-lactam antibiotics. If an allergic reaction occurs, the drug should be discontinued.
Prolonged use may occasionally result in overgrowth of nonsusceptible organisms.
Pseudomembranous colitis has been reported with nearly all antibiotics, including Meropenem (MEROMAX 500/MEROMAX 1000), and may range in severity from mild to life-threatening. It is important, therefore, to consider this diagnosis in patients who present with diarrhea subsequent to the administration of any antibiotics.
After diagnosis of pseudomembranous colitis has been established, therapeutic measures should be initiated.
Effects on Ability to Drive and Use Machines: There is no evidence to suggest that Meropenem (MEROMAX 500/MEROMAX 1000) may have an effect on a patient's ability to drive or operate machinery.

Use In Pregnancy & Lactation

Pregnancy: Animal reproduction studies have revealed no evidence of harm to the foetus.
The only adverse effect observed in animal reproductive studies was an increased incidence of abortions in monkeys at 13 times the expected exposure in man. There are no adequate and well controlled studies in pregnant women.
Meropenem (MEROMAX 500/MEROMAX 1000) should not be used in pregnancy unless the potential benefit justifies the potential risk to the foetus.
Lactation: Meropenem (MEROMAX 500/MEROMAX 1000) is detectable at very low concentrations in animal breast milk.
Meropenem (MEROMAX 500/MEROMAX 1000) should not be used in breast-feeding women unless benefit justifies the potential risk to the baby.

Adverse Reactions

Local reactions: pains, inflammation, thrombophlebitis at the site of injection.
Dermatologic reactions: urticaria, rash, pruritus, erythema multiforme, toxic epidermal necrolysis and Stevens-Johnson Syndrome.
Gastrointestinal: nausea, vomiting, abdominal pain, diarrhoea, pseudomembranous colitis.
Haematology: increase eosinophils, reversible thrombocythaemia, thrombocytopenia, leucopenia, neutropenia, agranulocytosis, positive direct or indirect Coomb's test, shortened partial thromboplastin.
Hepatic: increased transaminases, alkaline phosphatase, LDH and bilirubin.
Central nervous system: paraesthesia, headache, seizures.
Systemic allergic reaction: rarely, systemic allergic reaction (hypersensitivity) may occur following administration of meropenem (MEROMAX 500/MEROMAX 1000), angioedema and anaphylaxis.
Other: oral and vaginal candidosis.

Drug Interactions

Probenecid: Inhibits renal excretion of meropenem (MEROMAX 500/MEROMAX 1000) thereby increasing its plasma concentrations and prolonging its elimination half-life. Therefore, the co-administration of probenecid with meropenem (MEROMAX 500/MEROMAX 1000) is not recommended.
Valproic acid: Meropenem (MEROMAX 500/MEROMAX 1000) may reduce serum levels of valproic acid to subtherapeutic levels.

Caution For Usage

Compatibilities: Meropenem is compatible with the following infusion fluids: Sterile water for injection, 0.9% Sodium chloride, 5% dextrose.
Instruction for Use/Handling: Refer to Dosage & Administration. Standard aseptic technique should be employed during constitution.
Shake constituted solution before use.
All vials are for single use only.

Storage

Store at temperatures not exceeding 30°C. Protect from light.
It is recommended to use freshly prepared solutions of Meropenem (MEROMAX 500/MEROMAX 1000) for IV injection.
Reconstituted product, maintains satisfactory potency at room temperature (up to 25°C) or under refrigeration (2-8°C), do not freeze as shown in the following table: See Table 3.
 



Reconstituted solution of the product in 5% dextrose solution should be used immediately.
Use only once or discard any remaining portion.

Action

Pharmacology: Pharmacodynamics: Meropenem (MEROMAX 500/MEROMAX 1000) is a carbapenem antibiotic for parenteral use, that is relatively stable to human dehydropeptidase-1 (DHP-1) and therefore, does not require the addition of an inhibitor of DHP-1.
Meropenem (MEROMAX 500/MEROMAX 1000) exerts its bactericidal action by interfering with vital bacterial cell wall synthesis.
The ease with which it penetrates bacterial cell walls, its high level of stability to all serine β-lactamases and its marked affinity for the Penicillin Binding Proteins (PBPs) explain the potent bactericidal action of meropenem (MEROMAX 500/MEROMAX 1000) against a broad spectrum of aerobic and anaerobic bacteria.
Meropenem (MEROMAX 500/MEROMAX 1000) is active in vitro against a wide range of bacteria including: Gram-positive aerobes: Bacillus spp., Corynebacterium diphtheriaeEnterococcus liquifaciensEnterococcus aviumListeria monocytogenesLactobacillus spp., Nocardia asteroidesStaphylococcus aureus (penicillinase negative and positive), Staphylococci-coagulase-negative; including Staphylococcus saprophyticusStaphylococcus capitisStaphylococcus cohniiStaphylococcus xylosusStaphylococcus warneriStaphylococcus hominisStaphylococcus simulansStaphylococcus intermediusStaphylococcus sciuriStaphylococcus lugdunensisStreptococcus pneumoniae (penicillin susceptible and resistant), Streptococcus agalactiaeStreptococcus pyogenesStreptococcus equiStreptococcus bovisStreptococcus mitisStreptococcus mitiorStreptococcus milleriStreptococcus sanguisStreptococcus viridansStreptococcus salivariusStreptococcus morbillorum, Streptococcus Group G, Streptococcus Group F, Rhodococcus equi.
Gram-negative aerobes: Achromobacter xylosoxidansAcinetobacter anitratusAcinetobacter lwoffiiAcinetobacter baumanniiAeromonas hydrophilaAeromonas sorbriaAeromonas caviaeAlcaligenes faecalisBordetella bronchisepticaBrucella melitensisCampylobacter coliCampylobacter jejuniCitrobacter freundiiCitrobacter diversusCitrobacter koseriCitrobacter amalonaticusEnterobacter aerogenesEnterobacter (PantoeaagglomeransEnterobacter cloacaeEnterobacter sakazakiiEscherichia coliEscherichia hermanniiGardnerella vaginalisHaemophilus influenzae (including β-lactamase positive and ampicillin resistant strains), Haemophilus parainfluenzaeHaemophilus ducreyiHelicobacter pyloriNeisseria meningitidisNeisseria gonorrhoeae (including β-lactamase positive, penicillin resistant and spectinomycin resistant strains), Hafnia alveiKlebsiella pneumoniaeKlebsiella aerogenesKlebsiella ozaenaeKlebsiella oxytocaMoraxella (BranhamellacatarrhalisMorganella morganiiProteus mirabilisProteus vulgarisProteus penneriProvidencia rettgeriProvidencia stuartiiProvidencia alcalifaciensPasteurella multocidaPlesiomonas shigelloidesPseudomonas aeruginosaPseudomonas putidaPseudomonas alcaligenesBurkholderia (PseudomonascepaciaPseudomonas fluorescensPseudomonas stutzeriPseudomonas pseudomalleiPseudomonas acidovoransSalmonella spp. including Salmonella enteritidis/typhiSerratia marcescensSerratia liquefaciensSerratia rubidaeaShigella sonneiShigella flexneriShigella boydiiShigella dysenteriaeVibrio choleraeVibrio parahaemolyticusVibrio vulnificusYersinia enterocolitica.
Anaerobic bacteria: Actinomyces odontolyticusActinomyces meyeriBacteroides-Prevotella-Porphyromonas spp., Bacteroides fragilisBacteroides vulgatusBacteroides variabilisBacteroides pneumosintesBacteroides coagulansBacteroides uniformisBacteroides distasonisBacteroides ovatusBacteroides thetaiotaomicronBacteroides eggerthiiBacteroides capsillosisPrevotella buccalisPrevotella corporisBacteroides gracifisPrevotella melaninogenicaPrevotella intermediaPrevotella biviaPrevotella splanchnicus, Prevotella oralisPrevotella disiensPrevotella rumenicolaBacteroides ureolyticusPrevotella orisPrevotella buccaePrevotella denticolaBacteroides leviiPorphyromonas asaccharolyticasBifidobacterium spp., Bilophila wadsworthiaClostridium perfringensClostridium bifermentansClostridium ramosumClostridium sporogenesClostridium cadaverisClostridium sordelliiClostridium butyricumClostridium clostridiiformisClostridium innocuumClostridium subterminaleClostridium tertiumEubacterium lentumEubacterium aerofaciensFusobacterium mortiferumFusobacterium necrophorumFusobacterium nucleatumFusobacterium variumMobiluncus curtisiiMobiluncus mulierisPeptostreptococcus anaerobiusPeptostreptococcus microsPeptostreptococcus saccharolyticusPeptococcus saccharolyticusPeptostreptococcus asaccharolyticusPeptostreptococcus magnusPeptostreptococcus prevotiiPropionibacterium acnesPropionibacterium avidumPropionibacterium granulosum.
Stenotrophomonas maltophiliaEnterococcus faecium and methicillin-resistant staphylococci have been found to be resistant to meropenem.
Susceptibility test: Meropenem (MEROMAX 500/MEROMAX 1000) is stable in susceptibility tests and these tests can be performed using normal routine methods. In vitro tests show that meropenem (MEROMAX 500/MEROMAX 1000) acts synergistically with various antibiotics. It has demonstrated both in vitro and in vivo that meropenem (MEROMAX 500/MEROMAX 1000) has a post-antibiotic effect.
A single set of meropenem (MEROMAX 500/MEROMAX 1000) susceptibility criteria are recommended based on pharmacokinetics and correlation of clinical and microbiological outcomes with zone diameter and Minimum Inhibitory Concentration (MIC) of the infecting organisms.
The following susceptibility ranges have been established for meropenem (MEROMAX 500/MEROMAX 1000). (See Table 1.)
 



Pharmacokinetics: A 30 minutes intravenous infusion of a single dose of Meropenem (MEROMAX 500/MEROMAX 1000) in healthy volunteers results in peak plasma levels of approximately 11 μg/mL for the 250 mg dose, 23 μg/mL for the 500 mg dose and 49 μg/mL for the 1 g dose.
However, there is no absolute pharmacokinetic proportionality with the administered dose both as regards Cmax and AUC. Furthermore, a reduction in plasma clearance from 287 to 205 mL/min for the range of dosage 250 mg to 2 g has been observed.
A 5 minute intravenous bolus injection of Meropenem (MEROMAX 500/MEROMAX 1000) in healthy volunteers results in peak plasma levels of approximately 52 μg/mL for the 500 mg dose and 112 μg/mL for the 1 g dose.
Intravenous infusions of 1 g over 2 minutes, 3 minutes and 5 minutes were compared in a three-way crossover trial. These durations of infusion resulted in peak plasma levels of 110, 91 and 94 microgram/mL, respectively.
After an IV dose of 500 mg, plasma levels of meropenem (MEROMAX 500/MEROMAX 1000) decline to values of 1 μg/mL or less, 6 hours after administration.
When multiple doses are administered at 8 hourly intervals to subjects with normal renal function, accumulation of meropenem (MEROMAX 500/MEROMAX 1000) does not occur.
In subjects with normal renal function, meropenem's elimination half-life is approximately 1 hour. Plasma protein binding of meropenem (MEROMAX 500/MEROMAX 1000) is approximately 2%.
Approximately 70% of the administered dose is recovered as unchanged meropenem (MEROMAX 500/MEROMAX 1000) in the urine over 12 hours, after which little further urinary excretion is detectable.
Urinary concentrations of meropenem (MEROMAX 500/MEROMAX 1000) in excess of 10 μg/mL are maintained for up to 5 hours after the administration of a 500 mg dose. No accumulation of meropenem (MEROMAX 500/MEROMAX 1000) in plasma or urine was observed with regimens using 500 mg administered every 8 hours or 1 g administered every 6 hours in volunteers with normal renal function.
The only metabolite of meropenem (MEROMAX 500/MEROMAX 1000) is microbiologically inactive.
Meropenem (MEROMAX 500/MEROMAX 1000) penetrates well into most body fluids and tissues including cerebrospinal fluid of patients with bacterial meningitis, achieving concentrations in excess of those required to inhibit most bacteria.
Studies in children have shown that the pharmacokinetics of Meropenem (MEROMAX 500/MEROMAX 1000) in children are similar to those in adults. The elimination half-life for meropenem (MEROMAX 500/MEROMAX 1000) was approximately 1.5 to 2.3 hours in children under the age of 2 years and the pharmacokinetics are linear over the dose range of 10 to 40 mg/kg.
Pharmacokinetic studies in patients with renal insufficiency have shown the plasma clearance of meropenem (MEROMAX 500/MEROMAX 1000) correlates with creatinine clearance. Dosage adjustments are necessary in subjects with renal impairment.
Pharmacokinetic studies in the elderly have shown a reduction in plasma clearance of meropenem which correlated with age-associated reduction in creatinine clearance.
Pharmacokinetic studies in patients with liver disease have shown no effects of liver disease on the pharmacokinetics of meropenem (MEROMAX 500/MEROMAX 1000).

MedsGo Class

Other Beta-Lactams

Features

Brand
Meromax
Full Details
Dosage Strength
500 mg
Drug Ingredients
  • Meropenem
Drug Packaging
Powder for Injection (I.V.) 1's
Generic Name
Meropenem Trihydrate
Dosage Form
Powder For Injection (I.V.)
Registration Number
DR-XY36384
Drug Classification
Prescription Drug (RX)
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